April 1, 2024
FOR IMMEDIATE RELEASE
Press contact: cohenmilstein@berlinrosen.com
FORMER WAKE FOREST UNIVERSITY AND NBA STAR RODNEY ROGERS SUES BLUE CROSS BLUE SHIELD OF NORTH CAROLINA FOR DENIAL OF CRITICAL IN-HOME NURSING CARE
In 2008, Rogers was left a ventilator-dependent quadriplegic following a traumatic dirt bike accident
Blue Cross Blue Shield of North Carolina denied in-home nursing care for Rogers in 2023 despite deeming this care “medically necessary” for years prior
RALEIGH, NC – Former NBA star Rodney Rogers has filed a lawsuit against Blue Cross Blue Shield of North Carolina (BCBSNC) accusing the insurance carrier of wrongly denying Rogers, a ventilator-dependent quadriplegic, of in-home nursing care, which is an essential part of his specialized and medically necessary in-home medical care coverage.
Rogers, who after a standout career at Wake Forest University, played for the Los Angeles Lakers, Boston Celtics, Philadelphia 76ers and others, suffered a traumatic spinal cord injury from a dirt bike accident in 2008, rendering him a quadriplegic. Due to his injury, he is paralyzed from his neck down and is dependent on a ventilator. Like most quadriplegics, he requires constant specialized in-home medical care.
“Blue Cross Blue Shield of North Carolina covered in-home nursing care for years and denied this essential coverage without cause,” said Rodney Rogers. “This lapse in coverage has placed an enormous physical and emotional strain on my wife, who is not a specialized healthcare provider, and on me. This denial of coverage is particularly frustrating since I have already had to confront the harsh reality of once being a professional athlete and then becoming a ventilator-dependent quadriplegic, and now I’m facing the possibility of even more dire health issues because of BCBSNC’s healthcare denial.”
Rogers has been covered by BCBSNC since 2014. The policy provides that BCBSNC will cover or reimburse “members” and/or other eligible beneficiaries for medically necessary care or treatment. Under the terms of this policy, BCBSNC had continuously covered Mr. Rogers’ in-home nursing care, which was approved and deemed “medically necessary.”
In October 2022, Mr. Rogers was admitted to the hospital for multiple surgeries to repair a perforation of his stomach and to place a drain to treat pelvic abscesses. Following further surgery in December 2022, his medical providers sought renewed authorization of Mr. Rogers’ in-home nursing care so that he could return home from the hospital. On December 22, 2022, BCBSNC denied the coverage for nursing care that he’d always had, alleging for the first time that the care requested “does not meet the definition of Medical Necessity found in the [BCBSNC] member’s benefit booklet.” Mr. Rogers then landed back in the hospital in February and March 2023, but BCBSNC again denied nursing care when he was ready to go home, claiming that suddenly, Roger’s condition was now “stable” and that a family member could provide the care he needs, as outlined in the lawsuit.
“Mr. Rogers’ condition is very serious. Without the in-home nursing care that’s been provided to him for years before BCBSNC’s sudden change, Mr. Rogers could die from a complication of his illness or a malfunction of his medical equipment. It is rather astonishing that Blue Cross Blue Shield of North Carolina would suddenly deny the very care they’d always provided when there was no improvement in his health,” said Mac Sasser, partner at Sasser Law.
According to the lawsuit, Rogers requires in-home nursing care to address the daily onset of “mucus plugs” that develop in his airway passage, and the management and maintenance of life-sustaining equipment, such as his tracheostomy and feeding tubes. Despite multiple letters from Rogers’ physicians outlining why his in-home medical care remains necessary, and despite the hospital and doctor records of Rogers’ prolonged hospital visit in February and March 2023, BCBSNC still upheld its decision to deny this coverage.
“Although Mr. Rogers’ wife, Faye, has provided an enormous amount of support and care for her husband, she is not a trained medical professional, which is what he needs to stay alive,” said Theodore J. Leopold, partner at Cohen Milstein.
Rogers is represented by Charles McB. (“Mac”) Sasser and Rachel C. Matesic at The Sasser Law Firm and Theodore J. Leopold and Rachael Flanagan of Cohen Milstein. The lawsuit was filed in the North Carolina Superior Court for Durham County, in Durham NC.
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About The Sasser Law Firm, P.A.
The Sasser Law Firm, P.A. is a Charlotte, North Carolina litigation firm that regularly stands up for the rights of consumers and individuals against the largest insurance companies in the country. The firm represents all types of policyholders and beneficiaries in life insurance, disability insurance and health insurance cases. The firm also represents employees in all kinds of employer-provided benefit disputes, including life, disability, and health plans. For more information visit https://www.sasserlawoffice.com
About Cohen Milstein Sellers & Toll
Cohen Milstein Sellers & Toll PLLC, a premier U.S. plaintiffs’ law firm, with over 100 attorneys across eight offices, champions the causes of real people—workers, consumers, small business owners, investors, and whistleblowers—working to deliver corporate reforms and fair markets for the common good. For more information visit https://www.cohenmilstein.com